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Benefits Column

Navigating the Benefits Landscape

In preparation for her closing-session presentation at HRE's Health & Benefits Leadership Conference in March, our benefits columnist invited colleague Jen Benz to review the employee-benefits highlights of the past year and project what the landscape will look like in 2014.

Monday, January 13, 2014
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For me, there is something exciting about hanging a new calendar in my kitchen. It's the one analog device I retain in my life. On Jan. 1, I say a fond farewell to the prior year before tossing it in the trash and giving the next 365 days a public welcome.

The start of a new year still remains a brief hallmark of renewal for many people. In that spirit of a fresh start, I'm once again writing a shared column in the style of the New York Times' The Conversation -- much as I did with Harvard's Ron Kessler and Paychex's Bob Merberg.

My writing companion for this opinion piece is Jen Benz. I met Jen virtually several years ago when we both participated in the early CoHealth tweet chats. She captured my attention with her quick and insightful comments -- all expressed in less than 140 characters. Over the years we've become colleagues and now friends.

Jen is the program chair for Human Resource Executive's Health & Benefits Leadership Conference, and she asked me to be the speaker for the meeting's closing general session. Her charge? To share my opinion on the most intriguing ideas presented at the conference and fill in what I believe might have been missed. Jen never hands out small challenges. So, in the same spirit, I asked her to consider co-presenting with me. This column is a foreshadowing of what's to come during our March 19 presentation.

HARNETT: The last time we talked, you were winding down one of your most hectic years in the employee-benefits-communication industry. Most of your company's time was spent helping employers navigate health-insurance-benefits communication. What were your key takeaways from this experience?

BENZ: It was a busy year with healthcare reform adding complexity like never before. My biggest takeaway is that the role the employer plays in helping people manage and improve their health is more important than ever. And that a benefit manager's job is harder than ever before. And you?

HARNETT: I stepped up my attention to a few trending issues.

I believe the debate around employer-provided wellness programs is going to ramp up. In 2013, we witnessed people in the industry engage in heated exchanges about the return on investment and value on investment of prevention initiatives. The Penn State wellness debacle added other topics -- such as how to communicate benefits changes, privacy and the ethics of non-participation penalties -- to the conversation. 

For the first time, there was a lot more discussion about barriers that get in the way of employee engagement in health and wellness programs; issues such as caregiving, financial problems and relationship difficulties. In my opinion, employers will have to address these challenges if they want employees to remain healthy and productive.

BENZ: Absolutely. The wellness dialogue was fascinating. Looking ahead, I think we will soon see a change in the standard approach. As health insurance becomes a commodity, employers are going to have a hard time sustaining engagement in complex or punitive programs. Up until this point, they had a captive audience.

HARNETT: There are merits to all of the positions on how to maximize employee wellness, health and performance. I believe we need to blend the approaches into a cohesive strategy.

For instance, according to the Tufts-New England registry for comparative effectiveness, 20 percent of prevention initiatives produce cost savings and 10 percent cause unintentional harm. At minimum, employers can follow the Hippocratic oath and "first, do no harm." Then, they can consider some of the approaches to wellness that save money. Granted, the dollars saved associated with prevention are small but, as Dee Edington is now espousing, prevention programs can promote employee good will and trust if done correctly.

And, the counsel that Tom Emerick and Al Lewis provide around reducing employee stress, making healthy food choices at the workplace easy and referring employees with complex medical conditions to centers of excellence is also important as part of an overall approach to healthcare-cost management and employee performance.

BENZ: It is an interesting balance. Prevention and common-sense screening programs certainly can create good results and can definitely add to the employee experience. But they have to be backed up with programs that help people take good steps for their health, and a work culture that encourages that.

When you look at many programs, however, they focus on ongoing screening more than what you do to improve the results from your screening. And that can result in a lot of over testing.

One of the initiatives we've been closely involved with is Choosing Wisely. John Santa, the medical director at Consumer Reports, cautions employers about over-screening healthy employees. It is one of the causes of waste in the medical system.

HARNETT: I'm a fan of the Choosing Wisely program and believe that physicians and patients together discussing unnecessary testing is a step in the right direction in slowing the escalation of overall healthcare expenditures. How do you think employers will have to change their approach to wellness to slow this escalation in their own organizations?

BENZ:  Up until this point, much of wellness design was driven by cost control. Going forward, we will be asking: What will enhance the perceived value of wellness and employer-sponsored healthcare while still creating results for companies that need healthy and productive workers?

HARNETT: Tough question, with even more complicated potential strategies, Jen. If the evidence we use to measure the presence of healthy, productive employees in the workplace includes an organization's evolving portfolio of products and services as well as quality, profitability, earnings per share, repeat business and an expanding client base, then I believe employers will have to address issues such as employee resilience and vulnerability.

It's challenging for employees to focus on innovation and performance when they're struggling with personal challenges that require phone calls and meetings during the normal workday. And the financial burdens associated with caregiving and even divorce can feel insurmountable. 

Sure, employee assistance programs have been around for a long time, but they continue to be poorly utilized. Even though they've expanded their services, most don't address the changing world of caregiving and finances in a way that is meaningful to employees.

BENZ: I think you summed up the big challenge/opportunity right now: Employers have a huge set of employee-productivity issues they need to help support, but the current set of programs are not meeting needs. We see employers identifying these issues and thinking about ways to address them. But few are really creating and implementing new programs.

The majority choose to stay focused on regulatory changes, keeping up with healthcare reform and other compliance issues, which always takes precedence over innovation. And that's just the reality; when you have just a couple of people supporting complex programs for tens of thousands of individuals, there is little time for thinking ahead. But that's what we desperately need to be doing.

HARNETT: I see the greatest area for development and needed innovation in the area of vulnerability and employee challenges associated with life issues. But, to your prior point, there has not been a lot of innovation in this space.

Thought leaders such as Alexandra Drane and her company, Eliza Corp., are trying to measure and address employee vulnerability. Their Vulnerability Index may be the first viable product to measure the driving issues behind an employee's perception of his or her health -- and the costs that go along with that.

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BENZ: There are big opportunities for employers with support for caregivers and other family/financial management. And, personal financial security is a critical topic that will become more prominent as more and more workers are in high-deductible health plans.

The benefits industry has spent a lot of energy on retirement programs, but the focus on 401(k)s often ignores that most people are living paycheck to paycheck, without any emergency savings and often with mountains of debt. If we don't address those issues first, retirement plans will never be sufficient.

Likewise, efforts to provide access to -- and sometimes pay for -- backup child or elder care are of great value. If we don't address the full spectrum of what it takes to care for a young family or aging or disabled family members, the individual programs will never be enough.

HARNETT: The Eliza Corp. and Altarum Institute's shared white paper on vulnerability well-summarized the impact of these issues. It also pointed out that about 80 percent of surveyed individuals are willing to accept help from either employers or health-insurance companies to deal with financial stress. Plus, nearly all respondents (97 percent) sought help in managing caregiving-related issues.

The contrast between employees' stated needs and several of SHRM's summaries on workplace support services makes me think that employers may be trending the wrong way. The 2011 Employee Benefits survey found:

*     Only 1 percent of employers subsidized the cost of elder care -- down from 4 percent in 2008.

*     Just 2 percent offered access to elder care backup services -- down from 4 percent in 2007.

*     9 percent offered elder care referrals -- down from 22 percent in 2007; and

*     11 percent offered care leave above the federal Family and Medical Leave Act leave requirements, and 11 percent offered leave above state requirements for family leave -- down from 16 percent and 14 percent, respectively, in 2007.

Why do you think employers may be moving away from providing this type of assistance? And are there any relatively uncomplicated ways for them to step up these types of benefits outside of traditional EAPs?

BENZ: There could be any number of reasons why those numbers have gone down. Budgets for benefits that are not "essential" certainly have taken a hit, and sometimes it is hard to justify a program if it doesn't have widespread use or participation. Some companies still cling to a kind of "one-size-fits-all" approach to benefits and only want to invest in programs that are valuable to "all" employees.

But I suspect this touches on two other areas: HR managers' sheer bandwidth or ability to support any more programs than they already do and the lack of effective communications infrastructure, which makes rolling out new programs cost-prohibitive.

On the bandwidth issue, we touched on this a bit, but most benefits teams are working with half the staff they used to have, while navigating all the complexity of healthcare reform and other regulatory changes. It doesn't allow much time for new initiatives.

On the communications side, ineffective or nonexistent internal-communication channels hinder too many companies. They make supporting benefits -- particularly programs that fall outside of the typical annual enrollment cycle -- more difficult and time-consuming. When we surveyed HR managers a couple years ago, very few were using the channels -- like websites and social media -- that make ongoing communication less expensive and more effective.

We need to see a radical change in this for benefits to keep up with employee expectations, and for programs that support caregiving and holistic financial security to have any chance of success.

HARNETT: I could continue to talk with you, Jen, for hours on end. Thank you for writing this column with me. I look forward to more discussion in person and during our closing session in Las Vegas on March 19.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.

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